The reconstruction of arm and hand functions is of enormous importance for tetraplegic patients as it enables at least some degree of independence. Depending on the level of the spinal cord injury, certain residual functions are present in the arms which can be used for surgical reconstruction of upper extremity functions. By utilizing tendon and nerve transfers missing functions can at least be partially reconstructed. Tendon transfers are a proven technique with reliable results that can be performed at any time regardless of the type of accident. Due to the frequent presence of lower motor neuron damage, it is essential to consider the optimal time window for nerve transfer interventions. From the multitude of surgical options, an individual reconstruction plan must be created for each patient, which considers multiple factors. The combination of nerve transfers and later completing the functional reconstruction by tendon transfers is the preferred concept of the authors of this article.
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